Mortality associated with acute respiratory distress syndrome, 2009-2019: a systematic review and meta-analysis

Divyajot Sadana; Simrat Kaur; Kesavan Sankaramangalam; Ishan Saini; Kinjal Banerjee; Matthew Siuba; Valentina Amaral; Shruti Gadre; Heather Torbic; Sudhir Krishnan; Abhijit Duggal

doi:10.51893/2022.4.OA4

Mortality associated with acute respiratory distress syndrome, 2009-2019: a systematic review and meta-analysis

Crit Care Resusc. 2023 Oct 16;24(4):341-351. doi: 10.51893/2022.4.OA4. eCollection 2022 Dec 5.

Authors

Affiliations

¹ Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, (OH), USA.
² Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, (OH), USA.
³ Department of Internal Medicine, Saint Peter's University Hospital/Rutgers Robert Wood Johnson Medical School, New Brunswick, (NJ), USA.
⁴ Windsor University School of Medicine, Cayon, Saint Kitts and Nevis, West Indies.
⁵ Department of Internal Medicine, Geisinger Medical Center, Danville, (PA), USA.
⁶ Department of Pharmacy, Cleveland Clinic, Cleveland, (OH), USA.

Abstract

Background: Acute respiratory distress syndrome (ARDS) occurs commonly in intensive care units. The reported mortality rates in studies evaluating ARDS are highly variable. Objective: To investigate mortality rates due to ARDS from before the 2009 H1N1 influenza pandemic began until the start of coronavirus disease 2019 (COVID-19) pandemic. Design: We performed a systematic search and then ran a proportional meta-analysis for mortality. We ran our analysis in three ways: for randomised controlled trials only, for observational studies only, and for randomised controlled trials and observational studies combined. Data sources: MEDLINE and Embase, using a highly sensitive criterion and limiting the search to studies published from January 2009 to December 2019. Review methods: Two of us independently screened titles and abstracts to first identify studies and then complete full text reviews of selected studies. We assessed risk of bias using the Cochrane RoB-2 (a risk-of-bias tool for randomised trials) and the Cochrane ROBINS-1 (a risk-of-bias tool for non-randomised studies of interventions). Results: We screened 5844 citations, of which 102 fully met our inclusion criteria. These included 34 randomised controlled trials and 68 observational studies, with a total of 24 158 patients. The weighted pooled mortality rate for all 102 studies published from 2009 to 2019 was 39.4% (95% CI, 37.0-41.8%). Mortality was higher in observational studies compared with randomised controlled trials (41.8% [95% CI, 38.9-44.8%] v 34.5% [95% CI, 30.6-38.5%]; P = 0.005). Conclusions: Over the past decade, mortality rates due to ARDS were high. There is a clear distinction between mortality in observational studies and in randomised controlled trials. Future studies need to report mortality for different ARDS phenotypes and closely adhere to evidence-based medicine. PROSPERO registration: CRD42020149712 (April 2020).